Neurointerventional Treatments for Acute Stroke

Stroke is a life-threatening medical condition characterized by a sudden catastrophic breakdown in the brain-supporting cerebrovascular system and blood supply, which, in many instances, is followed by an irreversible injury to the brain cells and severe neurological impairment or death.

Notwithstanding the remarkable progress in medical science and technology and associated improvements in clinical practices, stroke continues to constitute the major public health problem in the U.S. and overseas. According to the World Health Organization (WHO), OECD, and governments’ data, approximately 14 million to 16 million people worldwide suffered a stroke in 2014, of which roughly 75% of the cases (10.5 – 12.0 million) represented first attacks and 25% (or 3.5 to 4.0 million cases) were qualified as recurrent attacks. Based on the same sources, about 5 million acute stroke episodes result in death within one year globally, which makes it the third most common cause of death, behind diseases of the heart and cancer.

Stroke is also a leading cause of serious and lasting disability and long-term institutionalized care.

Acute stroke – also known as “cerebrovascular accident” – represents a catastrophic manifestation of accumulated circulatory disorders that affect the vasculature of the brain. The two major subdivision of stroke are ischemia or lack of blood and oxygen supply typically resulting from occlusion of cerebral arteries, and hemorrhage or leakage of blood outside the normal cerebral vessel conduit. Both types of stroke cause necrosis of certain groups of brain cells, which leads to irreversible impairment of various neurological functions in about 22% to 25% of patients and death within one year in another 20% to 25% of stroke caseloads.

Acute stroke is managed by a broad scope of prophylactic, palliative and curative treatment regimens that are typically employed in some combinations during the preventive, acute and rehabilitation phases of stroke-related care delivery.

Although sales are low now, one of the fast(er) growing areas in the neurointerventional management of stroke is technologies to provide closure of the left atrial appendage, a vestige of the embryonic left atrium which, for patients with atrial fibrillation, can result in the formation of blood clots in the relatively stagnant pooled blood in the appendage.

Currently, only the Watchman LAA Closure System is approved in the U.S. for left atrial appendage closure, but sales are now projected to grow at 13% annually through 2019. Consequently, the make-up of the market will change considerably from 2014 to 2019: